A burst fracture is a severe injury where a vertebra breaks under such intense pressure that its cylindrical body shatters, pushing bone fragments outward. The primary concern is that these displaced bone fragments can narrow the spinal canal, the protective channel for the spinal cord, and pose a risk to the neural structures within.
Causes and Common Symptoms
Burst fractures are most often the result of high-energy trauma that applies a sudden, forceful vertical load to the spine. Common scenarios include motor vehicle accidents, significant falls from a height, or severe sports-related impacts. For individuals with compromised bone integrity, such as those with osteoporosis or spinal tumors, a burst fracture can occur with much less force.
The most immediate symptom is moderate to severe back pain at the injury site that worsens with movement. If bone fragments press on the spinal cord or nerve roots, neurological symptoms like numbness, tingling, or weakness in the limbs can develop. The loss of bladder or bowel control is a “red flag” symptom that signals significant spinal cord pressure and requires urgent medical evaluation.
The Diagnostic Process
Diagnosing a burst fracture begins with a physical and neurological examination. A doctor will assess the back for visible signs of injury and evaluate a patient’s muscle strength, sensation, and reflexes in the limbs. This initial assessment helps determine the extent of any potential neurological deficit.
Imaging tests are used to confirm the diagnosis and evaluate the fracture’s severity. An X-ray is often the first step, providing a general view of spinal alignment and the fractured vertebra. A Computed Tomography (CT) scan is the most effective tool, producing detailed, cross-sectional images that precisely show the fracture pattern and the location of any bone fragments in the spinal canal.
To assess the condition of surrounding soft tissues, a Magnetic Resonance Imaging (MRI) scan may be ordered. An MRI is particularly useful for visualizing the spinal cord, nerves, and ligaments. It can reveal any bruising, swelling, or direct injury to the spinal cord itself, which helps in determining the course of treatment.
Treatment Approaches
Treatment for a burst fracture depends on the spine’s stability and the degree of nerve compression. For stable fractures where the spine’s structural integrity is not significantly compromised and there is no neurological involvement, non-surgical treatment is an option. This involves immobilizing the spine with a custom-molded brace, like a Thoracolumbosacral Orthosis (TLSO), to allow the vertebra to heal over 8 to 12 weeks.
Surgery is required for unstable fractures or when bone fragments are compressing the spinal cord or nerves. The primary goals are to decompress the neural elements by removing bone fragments and to stabilize the spine. A spinal decompression is performed to remove the pieces of bone, often followed by a spinal fusion.
During a fusion, orthopedic hardware like screws and rods connect the injured vertebra to adjacent healthy vertebrae. Bone graft material is then placed in the area to encourage the bones to heal into a single, solid unit over time. This process restores stability by locking the injured segment in place.
The Recovery Journey
Following either bracing or surgery, recovery is a gradual process centered on rehabilitation. Physical therapy is a primary component, designed to help patients safely regain strength in the muscles supporting the spine. It also helps improve overall mobility and teaches proper body mechanics to prevent future injury.
The recovery timeline varies and can take several months. Initially, activities like bending, lifting, and twisting are strictly limited to protect the healing spine. These restrictions are gradually lifted by the medical team as the bone heals and strength returns.
Managing discomfort is also part of the recovery process. Some level of pain is expected as the body heals, and it can be managed with prescribed medications and other therapeutic modalities. Patients work closely with their doctors to find the most effective pain management strategy.